Provider Demographics
NPI:1508858994
Name:GENERATIONS AT REGENCY, LLC
Entity Type:Organization
Organization Name:GENERATIONS AT REGENCY, LLC
Other - Org Name:REGENCY MANOR NURSING & REHABILITATION CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-675-7979
Mailing Address - Street 1:6631 N MILWAUKEE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4416
Mailing Address - Country:US
Mailing Address - Phone:847-647-7444
Mailing Address - Fax:847-647-6403
Practice Address - Street 1:6631 N MILWAUKEE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4416
Practice Address - Country:US
Practice Address - Phone:847-647-7444
Practice Address - Fax:847-647-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
786OtherBLUE CROSS & BS
786OtherBLUE CROSS & BS
IL6338340001Medicare NSC
145237Medicare Oscar/Certification